Chronic disease, now the predominant form of disease in this country, creates major problems for the healthcare system; therapies are ameliorative rather than curative and chronicity creates recurrent and growing costs. Effective and efficient management over time is essential, but there is scant agreement on how best to pursue this goal. The forgoing circumstances are not inevitable. Evidence now indicates that health services can (1) achieve equal or better health outcomes while (2) reducing costs and (3) increasing satisfaction for both patients and health professionals. To achieve these goals, changes in the roles of patients and families in the process of care are necessary. One likely change is participation in self-management practices which have increasingly been shown to be effective. Evidence is also emerging that perceived self-efficacy to cope with the consequences of chronic disease is an important mediator of effective self-management, and that health education can significantly enhance perceived self-efficacy. This proposed project will: (1) conduct an experimental health education program for self-management by patients with the four chronic diseases of chronic obstructive pulmonary disease, coronary artery disease with angina, neurological disease with normal mentation and chronic arthritis, (2) assess the subsequent use of self-management practices and their impact on health status and health service utilization, (3) determine changes in perceived self-efficacy and the relationship of those changes to health status and health service utilization and (4) observe the effectiveness of the program for patients receiving health care in three different types of service systems. The design is a three year time series interrupted by an educational intervention. Within the time series is a six month randomized study. Subjects will be persons over the age of sixty. Educational content of the program will revolve around six categories of self-management skills taught through guided mastery training designed to enhance perceived self-efficacy. Data will be collected at six month intervals on use of self-management practices, health status, health service utilization, perceived self-efficacy levels, and satisfaction with health care. We hypothesize that: (1) health education for self-management will result in sustained use of beneficial self-management practices, (2) health status will improve and use of health services will decline, (3) the psychological trait of perceived self-efficacy to cope with the consequences of chronic disease will increase, (4) perceived self-efficacy levels and changes will correlate with levels and changes in health status and health service use and (5) the beneficial effects of the self-management program will be additive to existing medical treatment regimens.